Genitourinary Flashcards
Gold standard investigation for suspected renal colic
Non-contrast CT Kidney, Ureter, Bladder
1L = X-ray KUB
Investigation for suspected renal colic if pregnant
Abdominal Ultrasound
Why do we not want to use contrast very often?
Contrast raises risk of anaphylactic reactions
Tamsulosin uses and pharmacology
Uses: BPH tx
A1-Adrenergic Antagonist
Blocks A1a and A1b receptors in the prostate > smooth muscle relaxation > better urine flow
Acts on GU AND vessel smooth muscle :. can cause low BP
What is the difference between alpha and beta adrenergic receptors
Alpha: stimulate effector cells - vasoconstrict
smooth muscle
Beta: relax effector cells - vasodilate smooth + cardiac muscle
Physiology + presentations of Nephritic Syndrome
Damaged glom. more permeable > protein from blood into nephron > PROTEINURIA
Albumin leaves blood > HYPOALBUMINAEMIA
Oncotic pressure falls (less protein in blood) > lowers osmotic pressure > water moves out of vessels into tissue > OEDEMA
Loss of protein > less lipid synthesis > more lipid remains in blood > HYPERLIPIDAEMIA, LIPIDURIA
What are we shitting our pants about when someone develops AKI
Hyperkalaemia
Bad kidney > can’t excrete K+ > hyperK > cardiac arrest
GFR Staging
*ml/min
1 : >90 + renal damage 2: 60-89 + renal damage 3a: 45-59 +/- renal damage 3b: 30-44 +/- renal damage 4: 15-29 +/- renal damage Stage 5: <15 = renal failure
Pt presents feeling nauseous with fatigue, pruritus, appetite-loss and restless legs, You note peripheral oedema and bloods show anaemia.
Likely diagnosis?
Chronic Kidney Disease
(Less EPO > Anaemia)
(Urea builds > n/v, metal-mouth, pruritus)
Pt presents with a abdominal lump and haematuria. They have a history of Hypertension and smoke.
Imaging shows Renal cysts. Likely diagnosis?
Polycystic Kidney disease
Pt presents with ^^oliguria, and a sharp creatinine rise.
Likely diagnosis? What electrolyte should you be worried of? What drug is contraindicated?
Acute Kidney Injury
Worry about Hyperkalaemia - tall T-waves
Dopamine contraindicated
Common causes of UTI?
KEEPS
Klebsiella - 10% E coli - 80% Enterococcus Proteus mirabilis - 5% S saphrophyticus - 5%
Pt presents with dysuria and nocturia. Their wee is cloudy.
Likely cause?
UTI
Pt presents with haematuria, flank pain and an abdominal mass.
Genetic tests reveal a mutation in Chromosome 3.
Likely diagnosis?
Von Hippel Lindau = malignant cancer of the PCT Epithelium
What is the most common abdominal malignancy in children?
Wilms’ Tumour = Nephroblastoma
Primitive renal tubes + mesenchymal cells
GOLD surgical Management for BPH
TURP
Gold medical management for BPH
2L management
alpha-blocker - Tamulosin, Doxazosin
5-a-reductase inhibitor
2L: Finasteride (hair)
Pt presents with severe intermittent abdominal pain. The pain is felt on their right side and testicles.
Upon going to the toilet, they noticed red urine. Pt is apyrexial.
Likely diagnosis?
Investigations?
KIDNEY STONES
- side -> testicles (loin to groin)
GOLD: Non-contrast CT KUB
Pt presents with painless haematuria. He works in a cloth-dying factory.
Likely diagnosis? RF? Investigations? Management?
Bladder Cancer - Transitional Cell Carcinoma
Investigations:
1L: Flexible cystoscopy
GOLD: CT Urogram
Management: TURBT
Transurethral Resection of Bladder Tumour
+ Mitomycin C Chemo
+ BCG immunotherapy (non-muscle invasive)
Types of bladder cancer
Transitional Cell Carcinoma
Squamous Cell Carcinoma
Adenocarcinoma
Small Cell Bladder Cancer
Risk factors for Transitional Cell Carcinoma (bladder)
- SMOKING
- Aromatic amines (rubber, dyes)
- Cyclophosphamide
TCC SAC
Risk factors for Squamous cell carcinoma (bladder)
- Schistosomiasis infection
- Long-term catheter (10+ yr)
Risk factors for Adenocarcinomas (bladder)
- Local bowel cancer
- Other bladder cancers
Risk factors for Small cell carcinomas (bladder)
- Other bladder cancers
Bladder cancer typically metastasises to…
Lungs
Liver
Bone
Pt presents with painless haematuria.
Investigations?
Presume bladder cancer.
1L: Flexible cystoscopy
GOLD: CT Urogram (RF present)
USS KUB if no RF present
TURBT = Diagnostic AND therapeutic
Management of Bladder cancer
TURBT: Transurethral Resection of Bladder Tumour
Intravesical therapy:
- Mitomycin C chemo
- BCG immunotherapy
Muscle-invasive:
- Radical cystectomy
- Ileal conduit
Pt presents with discharge, fever, and testicular pain.
What investigation should you do to check for an STI?
Nucleic Acid Amplification test
- chlamydia
- gonorrhoea
CKD Diagnosis
What diagnoses end-stage renal failure?
eGFR <60
- 2 measurements
- 3 months apart
<15 = end-stage renal failure
What are the different types of renal cell carcinoma?
Which is most common?
1 CLEAR CELL CARCINOMA (75%)
BPH Management
1L Alpha blocker
a) Tamsulosin
2L 5-alpha reductase inhibitor
a) Finasteride
SURGICAL: Transurethral Resection of Prostate (TURP)
Overactive bladder management
1L Anticholinergic
a) Oxybutynin
Management of breast CA in post-menopausal F/ Gynaecomastia in M
AROMATASE INHIBITOR
a) Anastrozole
When is a UTI deemed complicated?
Man Immunocompromised Recurrent UTI Pregnant Structural defect Child
MIRPSC
Autosomal Dominant Polycystic Kidney Disease is a RF for which emergency event?
ADPKD»_space; Berry aneurysm»_space; Rupture»_space; SUBARACHNOID HAEMORRHAGE
Erectile Dysfunction management
Phosphodiesterase 5 inhibitors - Sildenafil
Also: pulmonary hypertension
Pt presents with gross haematuria, flank pain and a palpable abdominal mass.
Likely diagnosis?
Renal Cell Carcinoma (90%)
- Clear Cell Carcinoma (70% of RCC)
- Papillary Cell Carcinoma (10% of RCC)
